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General NPI Number Information
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NPI Number | 1194020768
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Entity Type | Individual
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Provider Name | STACIE MCNETT OTR
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Gender | Female
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 5205 OAKWOOD DR
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-9618
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Country | US
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Telephone | 716-625-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 234 OAKRIDGE AVE
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City | TONAWANDA
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State | NY
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Zip | 14217-1165
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Country | US
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Telephone | 716-909-8910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 007181
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 024001
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License Number State | NY
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